Dave's PCF WIP: Paragraphs

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View Edit Delete	PER-32	FIG. 14 illustrates an exemplary system 1400, according to one embodiment. The system 1000 may include a distal fibula resection guide 1410a, distal tibia resection guide 1420a, and may include one or more other complementary components 930. As explained above, the distal tibia resection guide 1420a can include a bone engagement surface 1026 configured to engage a medial surface of a first bone (e.g., tibia 224), one or more bone attachment features 1024 configured to couple the distal tibia resection guide 1420a to the first bone (e.g., tibia 224), one or more resection features 1022, and an alignment guide 1046 configured to orient the distal tibia resection guide 1420a relative to a longitudinal axis 1412 of the first bone (e.g., tibia 224). As explained more below, the distal fibula resection guide 1410a may include a bone engagement surface 1026 configured to engage a lateral surface of a second bone (e.g., fibula 226, in certain embodiments the distal fibula resection guide 1410a may not include a bone engagement surface 1026), one or more bone attachment features 1024 configured to couple the distal fibula resection guide 1410a to the second bone (e.g., fibula 226), one or more resection features 1022, and an alignment guide 1046 configured to orient the distal fibula resection guide 1410a relative to a longitudinal axis 1422 of the second bone (e.g., fibula 226).	216	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIGs. 14A-C illustrate different views of a stage of performing a surgical procedure. FIG. 14A illustrates an anterior perspective view of a foot and ankle including a tibia 224, fibula 226, talus 228, navicular 218, first metatarsal 208, and a second metatarsal 210. FIG. 14 illustrates one example of a distal tibia resection guide 1420a and a distal fibula resection guide 1410a coupled to the bones using bone attachment features that include fasteners 1010, e.g., K-wires. In one embodiment, a surgeon has formed a medial incision near the medial malleolus with a medial approach and a lateral incision near the lateral malleolus with a lateral approach. The surgeon has formed the incisions down to the cortical bone surface of both a medial surface of the distal end of the tibia 224 and a lateral surface of the distal end of the fibula 226. Further, the surgeon has cut, or moved to the side, soft tissue covering the cortical bone surface of the bones sufficient to seat a bone engagement surface 1026 of the distal tibia resection guide 1420a onto the cortical bone surface and the bone engagement surface 1026 of the distal fibula resection guide 1410a onto the cortical bone surface.	217	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	The surgeon has deployed two or more fasteners 1010 (e.g., K-wires) through the holes 1056 of the proximal bone attachment features 1058 and the distal bone attachment features 1060. In certain embodiments, the distal bone attachment feature 1060 and/or the proximal bone attachment feature 1058 can include an additional hole 1056 for another fastener 1010. The additional hole 1056 and fastener 1010 can help keep the resection guide 1020 in place during resection and alignment operations.	218	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 14B illustrates a medial perspective view of the foot and ankle. The distal tibia resection guide 1420a can be seen secured to the tibia 224. The proximal bone attachment feature 1058 and distal bone attachment feature 1060 are also illustrated. The fastener 1010 of the alignment guide 1046 is aligned with the longitudinal axis of the tibia 224. The fastener 1010 can identify for the surgeon that the distal tibia resection guide 1420a is in a desired location. Also, the landmark registration features 1028 is illustrated contacting the cortical surface and extending towards the posterior side of the tibia 224.	219	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 14C illustrates a close-up posterior perspective view of the tibia 224 and fibula 226 with both the distal tibia resection guide 1420a and the distal fibula resection guide 1410a secured to the bones. The proximal bone attachment feature 1058 and distal bone attachment feature 1060 are also illustrated. The resection features 1022 is visible. The one or more landmark registration features 1028 can be seen. In one embodiment, the landmark registration features 1028 is just large enough to serve its registration and/or placement function but no larger. Advantageously, a smaller and thinner landmark registration features 1028 can enable a surgeon to more readily confirm proper positioning and placement of the distal tibia resection guide 1420a on the bone surface. FIG. 14C also illustrates the distal fibula resection guide 1410a coupled to the fibula 226.	220	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 14D illustrates a close up anterior perspective view of the fibula 226 and tibia 224 with both the distal tibia resection guide 1420a and the distal fibula resection guide 1410a secured to the bones. The distal fibula resection guide 1410a is clearly shown while the distal tibia resection guide 1420a is obscured by the tibia 224.	221	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the distal fibula resection guide 1410a may include one or more of the same or similar features as the distal tibia resection guide 1420a. Thus, the distal fibula resection guide 1410a may include a resection feature 1022, a proximal bone attachment feature 1058, a distal bone attachment feature 1060, and/or an alignment guide 1046. In one embodiment, the resection features 1022 is configured to align with and enable resection of a wedge in the fibula 226 that corresponds to the wedge to be resected from the tibia 224. The proximal bone attachment feature 1058 and/or distal bone attachment feature 1060 enable the distal fibula resection guide 1410a to be secured to the fibula 226. The alignment guide 1046 enables a surgeon to confirm that the distal fibula resection guide 1410a is aligned with a longitudinal axis of the fibula 226 (in the illustrated embodiment the fastener 1010 is omitted for clarity).	222	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	At this stage a surgeon can resect the tibia 224 and/or the fibula 226 in which ever order desired. By resecting using a cutting tool in the resection features 1022 of the distal tibia resection guide 1420a and distal fibula resection guide 1410a a matching closing anterior wedge can be removed from both the tibia 224 and the fibula 226. Once the distal tibia resection guide 1420a and/or distal fibula resection guide 1410a are positioned and secured, the resection can be done with minimal concern that the resections will be different from those planned preoperatively.	223	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	After resection, two cut surface formed using the resection features 1022 may form a wedge shape of bone that can be removed to perform for example, a distal tibia anterior closing wedge osteotomy. A surgeon may then continue a surgical procedure to deploy an implant or a grant, and/or fuse the resected surfaces of the one or more bones.	224	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Certain bone surfaces may include minimal texturing and/or other landmarks that can facilitate registration with a guide. For example, the lateral surface of a fibula 226 may be very smooth. Consequently, guides for such bones may employ alternative features to achieve desired positioning, alignment, and/or orientation.	225	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the distal fibula resection guide 1410a may also include one or more landmark registration features 1028. However, those of skill in the art will appreciate that the fibula 226 has a very smooth lateral surface and thus offers few landmarks to facilitate positioning the distal fibula resection guide 1410a intraoperatively in a desired position and/or position called for in the intraoperative plan and/or as desired by the surgeon. Advantageously, the present disclosure provides one or more solutions that enable desired and/or proper placement of the distal fibula resection guide 1410a, even where few landmarks are present on the bone (e.g., the fibula 226). FIGs. 15A-C illustrate one example of a solution according to one embodiment.	226	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIGs 15A-15C illustrate close up views of the system 1400. The tibia 224 and fibula 226 are shown using a transparent representation to enable visualization of a placement feature 1510. In addition, the distal tibia resection guide 1420a and/or distal fibula resection guide 1410a are also illustrated using a transparent representation to further enable visualization of the placement feature 1510. In addition, certain fastener 1010 are omitted for clarity.	227	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	The placement feature 1510 is a feature that enables, facilitates, and/or supports positioning of one guide, instrument, or object on one side of one or more bones in relation to another guide, instrument, or object on another side of the one or more bones. In certain embodiments, a placement feature 1510 may be referred to as a transosseous placement feature because one or more aspects of the placement feature 1510 may traverse through a bone or bone tunnel in a bone.	228	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In the illustrated embodiment, the placement feature 1510 is configured to position an instrument on an opposite side a resection guide 920 such as, for example, a distal tibia resection guide 1420a. In one embodiment, the placement feature 1510 can be used to position and/or orient a guide or other instrument on a bone having few, if any landmarks that can be used for registration. For example, a distal tibia resection guide 1420a may readily register to a medial surface of a bone such as a tibia 224, while a distal fibula resection guide 1410a may have few, or no landmarks for registration on a surface of a bone, such as a fibular 226. In such a situation, the distal tibia resection guide 1420a may be placed and positioned first, and the placement feature 1510 can be used subsequently to position a distal fibula resection guide 1410a.	229	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Where one or more parts of the placement feature 1510 pass through a bone, the placement feature 1510 may be referred to as a transosseous placement feature 1510. In certain embodiments, the placement feature 1510 may pass through a plurality of bones, such as two or three or four, etc.	230	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	In one embodiment, the placement feature 1510 includes a first anchor 1520, a connector 1530, and a second anchor 1540. Alternatively, or in addition, in one embodiment the placement feature 1510 includes a first anchor 1520 and a connector 1530 with the second anchor 1540 being optional. The first anchor 1520 couples with the connector 1530 to maintain a position, orientation, and/or alignment of an instrument coupled to, or integrated with the first anchor 1520. The connector 1530 connects or couples the first anchor 1520 with another object such as a second anchor 1540, an instrument, a guide, an implant, or the like. In the illustrated embodiment, the connector 1530 is rigid. The second anchor 1540 couples with the connector 1530 to maintain a position, orientation, and/or alignment of an instrument coupled to, or integrated with the second anchor 1540.	231	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Advantageously, the aspects of the placement feature 1510 can be integrated with the aspects of one or more of other objects such as resection guides 920. In the illustrated embodiment, the placement feature 1510 is integrated with one or more of the bone attachment features 1024, fasteners 1010, and/or the alignment guide 1046.	232	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	Referring now to FIGs. 15A-15C, one example of a system 1400 that includes a single placement feature 1510 is illustrated. Those of skill in the art will appreciate that the system 1400 may include a plurality of placement features 1510 and that the location of the placement feature 1510 can be anywhere the placement feature 1510 provides the most value and benefit to a surgeon. In certain embodiments, a surgeon can direct that one or more placement features 1510 be included in the system 1400. FIG. 15A illustrates that a fastener 1010 of a bone attachment feature 1024 can serve as the connector 1530. The connector 1530 includes a proximal end 1532 and a distal end 1534. The connector 1530 extends from a medial side of the tibia 224 through to the lateral side of the tibia 224 and from a medial side of the fibula 226 to the lateral side of the fibula 226. The connector 1530 also extends into, and/or, through the distal fibula resection guide 1410a.	233	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 15B illustrates that a bone attachment feature 1024 can serve as a first anchor 1520. Of course, the first anchor 1520 can be separate from one or more bone attachment features 1024. FIG. 15B also illustrates that the first anchor 1520 can be positioned anywhere in, on, or around the body 1032.	234	Added by DJM Jan 2024	1/6/24, 9:49 PM
View Edit Delete	PER-32	FIG. 15C illustrates that an alignment guide 1046 can include a second anchor 1540. Of course, the first anchor 1520 can be separate from one or more bone attachment features 1024. FIG. 15B also illustrates that the first anchor 1520 can be positioned anywhere in, on, or around the body 1032.	235	Added by DJM Jan 2024	1/6/24, 9:49 PM

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